Provider Demographics
NPI:1346848249
Name:HOWARD, ELIZABETH MARY (DO4553)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:HOWARD
Suffix:
Gender:F
Credentials:DO4553
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1633 TAYLOR RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6754
Mailing Address - Country:US
Mailing Address - Phone:386-256-3510
Mailing Address - Fax:386-265-1969
Practice Address - Street 1:1633 TAYLOR RD UNIT 104
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6754
Practice Address - Country:US
Practice Address - Phone:386-256-3510
Practice Address - Fax:386-265-1969
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4553156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician